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The Misery of Cancer Patients!

2012, when I got admission in Indian Institute of Technology  Bombay (IIT-B), and started research on the treatment and diagnosis of cancer, thought that I had learned a lot about cancer. However, gravity of the problem was realized when I visited the government-supported cancer hospitals in Mumbai due to suffering of my brother-in-law from oral cancer. There, I found that patients were living on the footpath outside the hospital with operated mouth, nasal feeding tube, and many with bald head and masked faces after chemo and radiotherapy. They didn’t have the money to afford the accommodation, nor the hospital has the facility to accommodate these patients inside the premises. The oddity was that in front of that hospital, there was another one of the same name, and no patients were lying outside on the footpath. On asking people, found that it is the private hospital for rich patients. The treatment cost in private hospitals is much higher which can’t be afforded by the common man. The poor patients can’t go to the private hospital, because they don’t get what money use for food and what for the treatment.

On further interviewing the patients on the footpath, understood that they were waiting to meet doctors. When I went inside the government hospital, found the condition further worse. The patients were lying on the stairs with saline or medication bottle hanging nearby. Some have also vomited there, and people were crossing around and go. When I reached OPD with my brother-in-law, found it like some very popular event was happening and tickets have sold out. Patients have come from all over India and were waiting to meet the doctors from the past one to two days. They had hope that they will get the right treatment and get well soon.

I also submitted the case report of my brother-in-law for the doctor’s advice. The attendant said to come in evening thus we waited outside because there was no space to sit inside the hospital. When we returned to the hospital in the evening found that still, the afternoon patients were in line. The attendant told to come tomorrow morning. Next day, we got chance to meet doctor in afternoon. He suggested to start treatment asap but before it to undergo several tests. Then, we started going to the government hospital every or alternate day and waited for our number. It took us around a month to finish all the tests, and after that when we again met the doctor, he said us to go for surgery rather radiotherapy because cancer has spread to nearby healthy tissue and radiotherapy wouldn’t be much effective. Then we consulted the surgeon, and he said that most of the face and jaw part need to be removed and still only 60 % chance that cancer will not relapse. On hearing this, my brother-in-law became very sad and started complaining that if the tests would have been done quickly and treatment have started a month back, he would have higher chance to be treated successfully. Then, I realized that same thing is happening with most of the patients present here.

The unavailability of the right treatment at the right time is a major problem of developing countries like India apart from diverse side-effects of conventional treatments of cancer. The side-effects are mostly due to the nonspecific nature of cancer drugs and radiation. Like in chemotherapy, there are side-effects of systemic toxicity, failure of major organs, mucositis, sterility, hair loss, skin reaction, loss of blood and so many. In surgery, there is high chance of cancer relapse, body image, pain, and wound healing complications. Further, in India, the treatment of cancer costs around 4000-5000 USD. Thus, only 10 % of the cancer patients are able to afford the treatment while the rest drop in between and die. If anyhow, poor patients manage to get these treatments, majority of them land back to the hospital with cancer relapse at primary site or other organs. Finally, a stage comes, when patients stop fighting aggressively and focus on palliative treatment for having grace at the end of life!

All this lead me to realize the importance of quick and localized therapy on which I am doing the research, which is also cost-effective and side-effects free. However, I wondered, when these poor patients will be benefitted from these new treatment modalities?

There has been the development of several localized, cost-effective new treatment modalities such as magnetic hyperthermia, photodynamic therapy, photothermal therapy, etc. to circumvent the problems of conventional treatment. However, all of them have their own limitations such as in magnetic hyperthermia, toxicity risk due to inorganic nanoparticles and poor efficacy. In photodynamic therapy, problems due to toxicity of dye, e.g., skin related complications, headache, nausea, and inevitable systematic toxicity. In photothermal therapy, problem is in body clearance of photothermal agents and limited penetration depth of NIR (near-infrared) light.

In photothermal therapy, the nanoparticles used are plasmonic, i.e., the electrons of the nanoparticle couple to the far larger wavelength of electromagnetic radiation. It leads to the generation of heat which is exploited in the controlled and localized ablation of cancer cells without any significant effects on nearby healthy cells. Towards, increasing the efficacy of photothermal therapy,  several photothermal agents have been researched out, but the lack of degradation of nanoparticles and thereafter body clearance have remained unaddressed. It capped their potential to only preclinical studies without successful translation to the clinics. 

Thus, working on the physics, we developed biodegradable photothermal agents with the help of pharmaceutics and human physiology knowledge. The dielectric core material was chosen to be Food and Drug Administration (FDA) approved polymer, e.g., poly (lactic-co-glycolic acid) (PLGA) whose degradation results in lactic and glycolic acids which are natural metabolites and get absorbed in the body. While gold nanoshells on the surface of dielectric PLGA nanoparticles was fabricated by discrete attachment of nanoparticles rather continuous shell formation. This methodology was adopted because we hypothesized that when the laser light irradiated on the surface of nanoparticles, dielectric core will be hydrolyzed due to seepage of water and the gold nanoshells easily broken down to small gold nanoparticles (2-3 nm) which will be potentially renal cleared. Further, we avoided the usage of any anticancer drugs in contrast to other trending work of developing multifunctional drug-loaded nanoparticles. It helped in a way that nanoparticles didn’t cause toxicity on its degradation in liver, spleen and other major organs.

Although we have developed a non-toxic biodegradable photothermal agent and validated its superior efficacy both in vitro and in vivo studies, didn’t get support from the government or corporate world to carry this work further towards the clinical trial. We experienced that many investors showed interest at the starting but later no response. Also, we tried to get help from the start-up incubators and entrepreneurs, but again the same problem faced, i.e., no one had confidence to put money and take risk of clinical trials. Thus, thought of public support and started crowdfunding. It also didn’t go as expected, and we received very little support from the people.

There is an urgent need of quick and cost-effective cancer treatment in developing countries like India.

Later, I understood that it’s all because people have lost confidence due to prevalent bogus treatments of cancer available worldwide. Recently, FDA has given warning notices to more than 14 companies for fake cancer treatment. These are advertised to treat cancer by more than 65 means using natural and diet supplements. The directors of FDA Office of Enforcement and Import operation as well as of Consumer Safety said that it’s obvious for patient to be tempestuous for any treatment giving hope to cure cancer, however patients should be vigilant and avoid such bogus treatment because it’s unsafe and can cause the undefined side effects as well as accelerate the metastasis. They suggested rather to be treated by investigational drugs by getting enrolled in clinical trials.   

The members of our team also had to do the job to support their family, thus started disengaging from the project and joined elsewhere. The promising technology didn’t find the path due to thick clouds of bogus and deceitful treatments. The dream of translating side-effects free, localized and cost-effective technology to the poor patient seems shattered. The condition of the poor cancer patients has remained the same. It’s not only the failure of technology translation but also the loss of morale of the people dedicated themselves to poor cancer patients.

  1. Ashok says:

    In India, the translation of nanotechnology is difficult due to broken path of interdisciplinary science. However, it’s nice attempt…best wishes!

  2. XMC.pl says:

    I just added this feed to my favorites. I like reading your posts. Thank you!

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